The World Health Organization (WHO) advised this week that “sugar-free sweeteners should not be used as a means of weight control or to reduce the risk of non-communicable diseases.”
Artificial sweeteners are either natural or synthetic compounds that taste sweet like sugar—up to 400 times sweeter by weight—but provide no energy. By comparison, sugar contains 17 kilojoules (4 calories) per gram, so one teaspoon of sugar contains 85 kilojoules.
So what do the new WHO recommendations mean for people who turn to artificial sweeteners for health reasons? Should they go back to sugar?
Evangeline Manziouris, Program Director of Nutrition and Food Science and Registered Dietitian at the University of South Australia, spoke about how artificial sweeteners were advertised when they first appeared in processed foods as a way to replace sugar in foods that could lead to weight loss. . .
The average can of sweetened soft drink contains about 500 kilojoules. Theoretically, swapping one can of sugary soft drink for a can of artificially sweetened soft drink each day should reduce your weight by about 1 kilogram (2.2 pounds) per month.
But studies over the past few decades show that this is not the case.
What is the new advice based on?
WHO based its recommendation on a systematic review that it had undertaken. Its goal was to provide evidence-based guidance on the use of artificial sweeteners for weight management and disease prevention.
It is important to control weight as obesity increases the risk of diseases such as diabetes and some types of cancer, which are the leading cause of death worldwide.
The WHO systematic review includes data from different types of studies that give us different information:
• 50 randomized controlled trials (where scientists intervene and make changes – in this case diet – while keeping everything else the same, were selected to see the effect of those changes).
• 97 is a prospective cohort study (where scientists look at a risk factor in a large group of people over a period of time to see how it affects outcome—without intervention or making any changes).
• 47 were case and control studies (another type of observational study that tracks and compares two matched groups of people, regardless of the risk factor of interest).
RCTs provide us with causal evidence that allows us to say that an intervention led to the changes we observed.
Potential group and state control gives us only associations or connections. We can’t prove that the risk factors led to the change in the results—in this case, the weights—because other risk factors that the scientists didn’t account for could be responsible.
But they provide fascinating clues about what might happen, especially if we can’t do a trial because it’s unethical or unsafe to give or withhold certain treatments.
The WHO systematic review looked at obesity, noncommunicable diseases and mortality.
In regards to obesity, randomized controlled trials have shown that those who consumed more artificial sweeteners weighed slightly less – an average of 0.71 kg – than those who consumed less or no artificial sweeteners.
But cohort studies have shown that higher consumption of artificial sweeteners was associated with a higher body mass index (0.14 kg/m2) and a 76% increased risk of obesity.
Prospective cohort studies have shown that if people drank more artificially sweetened beverages, their risk of developing type 2 diabetes increased by 23%. And if artificial sweeteners were used as the main ingredient (the consumer added them to foods and drinks), the risk of developing diabetes increased by 34%.
And in people with diabetes, artificial sweeteners did not improve or worsen any of the clinical indicators used to monitor their diabetes, such as fasting blood sugar or insulin levels.
Higher intake of artificial sweeteners was associated with an increased risk of type 2 diabetes, cardiovascular disease, and death in long-term, prospective observational studies that followed participants for an average of 13 years.
But artificial sweeteners were not associated with differences in overall rates of cancer or premature death from cancer.
Overall, while randomized controlled trials have shown a slight increase in weight loss in people who used artificial sweeteners, observational studies have shown that this group tends to have an increased risk of obesity and poorer health outcomes.
Does the review have any drawbacks?
The recommendations of the World Health Organization have drawn some criticism, as randomized controlled trials have shown some weight loss benefits from the use of artificial sweeteners, albeit small ones.
However, the WHO makes it clear that its recommendations are based on multiple studies and not just randomized controlled trials.
In addition, the WHO rated the quality of the studies in the review as “low to very low certainty”.
This advice does not say that artificial sweeteners are unsafe or should be banned. The WHO scientific review did not address chemicals or safety issues.
So wouldn’t it be better for us to eat sugar instead? The answer is no.
In 2015, the World Health Organization issued recommendations for the consumption of added sugar to reduce the risk of being overweight and obese. Added sugars are found in highly processed and processed foods and drinks such as soft drinks, fruit drinks, sports drinks, chocolate, desserts, and flavored yogurts.
It recommends that people consume no more than 10% of their total energy intake, which is about 50 grams (ten teaspoons) of sugar per day for the average adult who needs 8,700 kilojoules per day.
The WHO recommendation is in line with the Australian Dietary Guidelines, which recommend no more than three servings of non-essential foods per day if you need extra energy. However, it is better to get additional energy from the main food groups (grains, vegetables, fruits, dairy products and protein group) and not from non-essential foods.
So, if artificial sugar in drinks is not recommended for weight loss, what can you drink?
Some options include water, tea or coffee. Sodas and mineral water flavored with a little of your favorite fruit juice are good alternatives.
Milk is also a good choice, especially if you are currently not meeting your calcium needs.
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